P–468 Fertility-related quality of life in subfertile women undergoing transvaginal hydrolaparoscopy versus hysterosalpingography as a first-line tubal patency test

Study question Is there a difference in fertility-related quality of life (QoL) in subfertile women undergoing transvaginal hydrolaparoscopy (THL) versus hysterosalpingography (HSG) as a first-line tubal-patency test? Summary answer In subfertile women undergoing first-line tubal patency testing, THL and HSG resulted in comparable fertility-related QoL. What is known already Both subfertility itself and subfertility treatment can have a significant impact on QoL. Tubal patency testing as part of fertility work-up is also known as a potential stressor. Pain scores for THL are significantly lower than for HSG (VAS 4.7 vs 5.4 ; SD: 2.5, p 0.038), but acceptability of the procedures was found to be comparable. Fertility-related QoL has not yet been studied in women undergoing tubal patency testing. Study design, size, duration We used data from a randomised clinical trial performed in 4 Dutch teaching hospitals, NTR3462. Between May 2013 and October 2016, we randomly assigned 300 subfertile women to THL or HSG with live birth as primary outcome. We performed a standardized questionnaire study as part of a randomised controlled trial comparing THL and HSG in the work-up for subfertility. Participants/materials, setting, methods Women were eligible if they were undergoing a fertility work-up with an indication for evaluation of tubal patency testing. Fertility-related QoL was measured six weeks after the procedure with the validated FertiQoL questionnaire, which produces a Core (total) score and four subscale domains: Emotional, Relational, Social, and Mind-Body. FertiQoL scores for the Core score and subscales between THL and HSG were compared using Mann-Whitney-U test and multiple linear regression analysis. Main results and the role of chance We allocated 149 women to THL and 151 to HSG. The questionnaire was completed by 84 women in the THL group (response rate 56%) and 96 women in the HSG group (response rate 64%). Core scores were 74.6 ±12.8 for THL and 73.4 ±12.4 for HSG (p = 0.39). Scores for the Emotional domain were 64.5 ±19.0 for THL versus 66.0 ±16.3 (p = 0.67) for HSG. Scores for the ‘Mind-body’ domain for THL were 76.9 ±15.6 versus 74.1 ±18.0 for HSG (p = 0.42), scores for the Relational domain were 79.2 ±12.9 for THL and 76.9 ±15.6 for HSG (p = 0.21). Scores for the Social domain for THL were 77.9 ±15.1 versus 76.7±14.1, (p = 0.42). The optional ‘Treatment FertiQol’ was completed by 156 women. Total scores were 77.5 ±12.1 for THL versus 73.8 ±13.1 (p = 0.08) for HSG. The multiple linear regression analysis showed only a statistical significant positive effect of higher age on the score for the Emotional domain (B:0.90, p = 0.015). Limitations, reasons for caution One of the main limitations of this study was a response rate of 60%. Although this is considered an acceptable rate within questionnaire research, this could lead to selection bias. Wider implications of the findings: In subfertile women, tubal patency testing with THL versus HSG did not result in differences in fertility-related QoL. Trial registration number NTR3462

Systematic use of transvaginal hydrolaparoscopy as a minimally invasive procedure in the exploration of the infertile patient: results and reflections

Background: The aim of this study was to evaluate the added value of transvaginal hydrolaparoscopy (THL) in the investigation of the infertile patient. Methods: A retrospective cohort study, based on records from 01/09/2006 to 30/12/2019 was undertaken in a tertiary care infertility centre. THL was performed in 2288 patients. These were patients who were referred for endoscopic exploration of the female pelvis as part of their infertility investigation. In 374 patients with clomiphene-resistant polycystic ovary syndrome (PCOS), ovarian capsule drilling was also performed. The outcome objectives of this study included the evaluation of the added diagnostic value of THL as well as the feasibility and safety of the visual inspection of the female pelvis using this technique. Results: Of the 2288 procedures failed access to the pouch of Douglas occurred in in 23 patients (1%). The complication rate was 0.74%, due to bowel perforations (n= 13) and bleeding (n= 4) requiring laparoscopy. All bowel perforations were treated conservatively, with 6 days of antibiotics, and no further complications occurred. Findings were normal in 49.8% of patients. Endometriosis was diagnosed in 366 patients (15.9%); adhesions were present in 144 patients. Conclusions: THL is a minimally invasive procedure, with a low complication and failure rate, providing an accurate visual exploration of the female pelvis in a one-day hospital setting. When indicated, minimally invasive surgery is possible in the early stages of endometriosis and for ovarian capsule drilling in patients with clomiphene-resistant PCOS.